Tobacco Use:

Data & Resources to Help Users Quit

November 15, 2013

Joanne Joy; j.joy@HCCAme.org

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Vision ◦ Healthy tobacco-free living for all people throughout Maine

Mission

◦ Enhance the capacity of Maine’s behavioral health

treatment and recovery systems to treat tobacco addiction

and promote tobacco-free living

Tagline

◦ Integrating tobacco treatment into all treatment programs

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2002 Coalition for Smoking or Health mini-grants ◦ A collaborative leadership group

Additional Partnership For A Tobacco-Free Maine (PTM) support over time ◦ Focus groups with clients of mental health and substance abuse

services

◦ Stakeholder interviews among providers

Forums held

Materials Developed, Website Created

Ongoing education and outreach

Always in collaboration with Helpline, PTM & HMPs

Current funding from Bingham Program to increase tobacco treatment for BH populations

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Myths about efficacy of & interest in tobacco treatment of individuals in BH populations

Data: Higher Tobacco Use Rates

Professional Development/Training for clinical/counseling and non-clinical staff

Resources ◦ Links to assist with tobacco-free policies, treatment

supports, research, etc.

Note on Community Transformation Grant:Behavioral Health Workgroup

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Myth #1: Tobacco dependence is less harmful than other addictions ◦ Those with alcohol, drug and/or other behavioral

health diagnosis are more likely to die from their tobacco use than from their other co-occurring conditions 1. Hser, Y. I., McCarthy, W. J., & Anglin, M. D. (1994). Tobacco use as a

distal predictor of mortality among long-term narcotics addicts. Preventive Medicine, 23, 61–69.

◦ There is greater mortality from tobacco use than from alcohol, illicit drugs, HIV, suicide, homicide, and motor vehicle accidents combined see chart later in

presentation

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Myth #2: Recovery from other addictions should come first ◦ Studies of smoking and alcohol treatment

indicate that concurrent treatment does not jeopardize abstinence from alcohol and other non-nicotine drugs 3. Prochaska, Delucchi, & Hall. (2004). A Meta-Analysis of

Smoking Cessation Interventions With Individuals in Substance Abuse Treatment or Recovery. Journal of Consulting and Clinical Psychology, 2004, Vol. 72, No. 6, 1144–1156

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Myth #3: Tobacco use is just a bad habit that people can address on their own ◦ As with other addictions, tobacco dependence is

a chronic, relapsing condition often requiring multiple, assisted quit attempts before long-term abstinence is achieved

◦ A combination of behavioral counseling and use of approved tobacco treatment medications have been found to significantly increase quit rates Fiore

MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service. May 2008

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Myth #4: They’ve given up enough. Why take away their last pleasure? ◦ Roughly 70% of all tobacco users want to quit. Roughly

50% will make at least one quit attempt each year 4. This population should be afforded the same opportunity and encouragement to quit tobacco as any other segment of the population. Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence:

2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service. May 2008

◦ People who achieve abstinence from tobacco report greater satisfaction in their lives. L. Shahab & R West, “Do ex-smokers

report feeling happier following cessation? Evidence from a cross-sectional survey”, Nicotine Tob Res. 2009 May;11(5):553-7.

◦ Recovery from tobacco dependence can ease financial burden, improve health, strengthen relationships and potentiate other positive life changes

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Myth #5: Quitting tobacco is too stressful for someone whose mental health status is already fragile.

◦ Studies have demonstrated that Individuals with psychiatric disorders can be aided in quitting smoking without threat to their mental health recovery Prochaska, J.,

“Failure to Treat Tobacco Use in Mental Health and Addiction Treatment Settings: A Form of Harm Reduction?”. Drug Alcohol Depend. 2010 August 1; 110(3): 177–182.

◦ People who use tobacco are found to experience more stress than non-users Parrot, A.C. “Does Cigarette Smoking Cause Stress?”, American

Psychologist, Vol 54(10), Oct 1999, 817-820

◦ Experiences in psychiatric hospitals have demonstrated that tobacco-free hospitals have resulted in fewer instances of seclusion and incidences of restraint as well as reduction in coercion and threats among patients and staff Tobacco-Free Living in Psychiatric Settings: A Best-Practices Toolkit Promoting Wellness and Recovery, 2007

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MPHA and partners are hosting a webinar series on tobacco-related issues starting in December.

The Raw Numbers: Tobacco Use and Control Data Review—The Maine Story ◦ January 16, 2014 ◦ Focused entirely on Maine tobacco data

◦ Tim Cowan, Maine's leading tobacco data expert, will be breaking down the data into county level, sub-populations, age groups, education levels, Mainecare usage and much more.

Date/Time: January 16, 2014, 2pm

Link to Register: https://www1.gotomeeting.com/register/223675408

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SAMHSA: The NSDUH Report, March 20, 2013 ◦ Adults with Mental Illness or Substance Abuse

Disorder Account for 40 Percent of All Cigarettes Smoked.

CDC Vitalsigns: Adult Smoking: Focusing on People with Mental Illness, February 2013

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More than 1 in 3 of adults (36%) with a mental illness smoke ◦ About 1 in 5 adults (21%) with no mental illness

About 3 of every 10 cigarettes (31%) smoked by adults are smoked by adults with a mental illness ◦ NSDUH Report found 4 of every 10 (40%)

Nearly 1 in 5 adults (or 45.7 million adults) have some form of mental illness

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CDC Vitalsigns Report:

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Smoking Rates have improved among People with Behavioral Health Diagnoses adapted from Shroeder, 2009

Disorder Smoking

Prevalence

Drug Abuse/Dependence 49-98%

Alcohol Abuse/Dependence Approx. 80%

Schizophrenia 45-88%

Bipolar 55-70%

PTSD 45-66%

Major Depression 40-60%

ADHD 41-42%

General Population 18%

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Slide adapted from Rx for Change

Approx. proportion of those with mental health diagnosis

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Behavioral Health

Variable

Higher than State Rate

Lower than State Rate

Symptoms of

Moderate to Severe

Depression

Current 37.5% smoke

No or

Mild 16.0% smoke

Depression Ever

told 26.8% smoke

Never

told 14.7% smoke

Anxiety Disorder Ever

told 28.2% smoke

Never

told 15.1% Smoke

Table 1: Behavioral Health / Smoking Status Data:

Maine Statewide Smoking Status by Mental Health Variable, BRFSS 2007,

2008-09 combined

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Rates of Anxiety and Depression from 2008 Maine household telephone survey (BRFSS)

7% Current Symptoms of Moderate to Severe Depression

20% Past History of Depression

16% Past History of Anxiety

Depression & Anxiety Among Maine people

2011 Maine General Population BRFSS ◦ 8 out of 10 (85.7%) of Maine current smokers are

“seriously considering quitting within the next 6 months”.

7 out of 10 BH tobacco users also want to quit

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FREE & available thru June 2014

Support to create tobacco-free policies

Awareness sessions for staff ◦ 45-90 minutes

“Talking Tobacco” trainings ◦ 90 minutes-2 hours

Helpers Training ◦ 4 hours

Substance Abuse treatment professionals workgroup: ◦ 4 meetings, 3 by distance

Website: www.project-integrate.org

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Partnership For A Tobacco-Free Maine (PTM), through Center For Tobacco Independence (CTI), offers the

following tobacco treatment training events.

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◦

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◦ 4/9/14 Opening Lines and Other Conversation Tips

for Talking about Tobacco To register: https://www2.gotomeeting.com/register/520858618

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Links to Maine Training Options http://www.tobaccofreemaine.org/train_take_action/training_and_events.php

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1-2% of smokers

access treatment

Of the remaining smokers who want to

quit, many could benefit from integrated

tobacco treatment as well as

Current use of Tobacco Treatment

Maine Tobacco Helpline (Video)

Websites: www.Ucanquit2.org

Nicotine Replacement Therapies

Other medical interventions ◦ Wellbutrin

◦ Chantix

Long term abstinence requires behavior changes

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Comprehensive Tobacco-Free Policies

Clear consistent messages

Integrated documentation at all stages of assessment, planning & referral/treatment

& Effective treatment by providers needs: ◦ Access to professional development

◦ Access to current research and information

◦ Tips on using existing skills such as motivational interviewing

◦ Effective referrals and follow-up

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Project Integrate: http://www.project-integrate.org/provider-resources.html

◦ Research Position Statements

Journal Articles

Statements from the Field

◦ State and National Resources Links to Maine Resources

Bringing Everyone Along http://www.tcln.org/bea/index.html

◦ Tobacco-Free Policies Several Maine BH facility policies

Link to the Maine Laws

Link to Breathe Easy Coalition

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http://www.project-integrate.org/provider-resources.html

Materials developed by Project Integrate Stages of Change

Why tobacco treatment with Substance Abuse Treatment

◦ Clinical Resources Guidance documents developed across the US

Tools to support tobacco treatment

◦ Training Opportunities – PTM/CTI A “click here” link at the bottom goes to the registration page

◦ Order Form: Materials developed by Project Integrate

Follow up with an email to j.joy@hccame.org

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Moving from one stage of change closer to Action and Maintenance

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Partnership For A Tobacco Free Maine www.PTMstore.org ◦ Newsletters, Facts, Laws ◦ Workplace Materials ◦ HelpLine Materials (1-800-207- 1230) ◦ Parents, Kids, and Schools ◦ Real Talk about Smoking ◦ Tobacco-Free Athletes ◦ NO BUTS! ◦ Second Hand Smoke

Create your own account at www.ptmstore.org

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www.thequitlink.com

Statewide 5 year effort

District Coordinating Councils

State level workgroups ◦ Physical Activity and Nutrition

◦ Primary Care Systems

◦ Two tobacco related

Behavioral Health Agency Tobacco Policies

LGBT tobacco use reduction

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Joanne E. A Joy Healthy Communities of the Capital Area

36 Brunswick Avenue, Gardiner, ME 04345

Office: 588-5011

Email: j.joy@HCCAme.org

www.healthycommunitiesme.org

Project Integrate www.project-integrate.org

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